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Definition

What is brachial plexus injury?

The brachial plexus is the network of nerves that sends signals from your spine to your shoulder, arm and hand. A brachial plexus injury occurs when these nerves are stretched, compressed, or in the most serious cases, ripped apart or torn away from the spinal cord.

Minor brachial plexus injuries, known as stingers or burners, are common in contact sports, such as football. Babies sometimes sustain brachial plexus injuries during birth. Other conditions, such as inflammation or tumors, may affect the brachial plexus.

The most severe brachial plexus injuries usually result from auto or motorcycle accidents. Severe brachial plexus injuries can leave your arm paralyzed, with a loss of function and sensation. Surgical procedures such as nerve grafts, nerve transfers or muscle transfers can help restore function.

How common is brachial plexus injury?

Please discuss with your doctor for further information.

Symptoms

What are the symptoms of brachial plexus injury?

The common symptoms of brachial plexus injury are:

  • Pain
  • Loss of sensation
  • Muscle weakness
  • Paralysis of some or all of the muscles of the shoulder and upper limb

Some patients may experience avulsion pain (a burning, crushing type of pain) in the distribution of the injured nerves.

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

You should contact your doctor if you have any of the following:

  • Recurrent burners and stingers
  • Weakness in your hand or arm
  • Weakness in any part of the arm following trauma
  • Complete paralysis of the upper extremity following trauma
  • Neck pain
  • Symptoms in both arms
  • Symptoms in upper and lower limbs

Causes

What causes brachial plexus injury?

  • Damage to the upper nerves that make up the brachial plexus tends to occur when your shoulder is forced down while your neck stretches up and away from the injured shoulder. The lower nerves are more likely to be injured when your arm is forced above your head. These injuries can occur in several ways, including:
  • Contact sports. Many football players experience burners or stingers, which can occur when the nerves in the brachial plexus get stretched beyond their limit during collisions with other players.
  • Difficult births. Newborns can sustain brachial plexus injuries when there are problems during birth, such as a breech presentation or prolonged labor. If an infant’s shoulders get wedged within the birth canal, there is an increased risk of a brachial plexus palsy. Most often, the upper nerves are injured, a condition called Erb’s palsy. Total brachial plexus birth palsy occurs when both the upper and lower nerves are damaged.
  • Several types of trauma — including motor vehicle accidents, motorcycle accidents, falls or bullet wounds — can result in brachial plexus injuries.
  • Inflammation may cause damage to the brachial plexus. A rare condition known as Parsonage-Turner syndrome (brachial plexitis) causes brachial plexus inflammation with no trauma and results in paralysis of some muscles of the arm.
  • Noncancerous (benign) or cancerous tumors can grow in the brachial plexus or put pressure on the brachial plexus or spread to the nerves, causing damage to the brachial plexus.
  • Radiation treatment. Radiation treatment may cause damage to the brachial plexus.

Risk factors

What increases my risk for brachial plexus injury?

There are many risk factors for brachial plexus injury, such as:

  • Participating in contact sports, particularly football and wrestling
  • Being involved in high-speed accidents

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is brachial plexus injury diagnosed?

To diagnose your condition, your doctor will review your symptoms and conduct a physical examination.

To help diagnose the extent and severity of a brachial plexus injury, you may have one or more of the following tests:

  • Electromyography (EMG). During an EMG, your doctor inserts a needle electrode through your skin into various muscles. The test evaluates the electrical activity of your muscles when they contract and when they’re at rest. You may feel a little pain when the electrodes are inserted, but most people can complete the test without much discomfort.
  • Nerve conduction studies. These tests are usually performed as part of the EMG, and measure the speed of conduction in your nerve when a small current passes through the nerve. This provides information about how well the nerve is functioning.
  • Magnetic resonance imaging (MRI). This test uses powerful magnets and radio waves to produce detailed views of your body in multiple planes. It often can show the extent of the damage caused by a brachial plexus injury and can help assess the status of arteries that are important for the limb or for reconstruction of it. New methods of high-resolution MRI, known as magnetic resonance neurography, may be used.
  • Computerized tomography (CT) myelography. Computerized tomography uses a series of X-rays to obtain cross-sectional images of your body. CT myelography adds a contrast material, injected during a spinal tap, to produce a detailed picture of your spinal cord and nerve roots during a CT scan. This test is sometimes performed when MRIs don’t provide adequate information.
  • If your doctor suspects that the blood vessels feeding your arm might be injured, he or she might suggest an angiogram — an imaging test where contrast material is injected into an artery or vein to check the condition of your blood vessels. This information is important in planning your surgical procedure.

How is brachial plexus injury treated?

Treatment depends on several factors including the severity of the injury, the type of injury, the length of time since the injury and other existing conditions.

Nerves that have only been stretched may recover without further treatment.

Your doctor may recommend physical therapy to keep your joints and muscles working properly, maintain the range of motion, and prevent stiff joints.

The healing process sometimes forms scar tissue that must be removed surgically to improve the nerve’s function. Surgical repair is often required for nerves that have significant surrounding scar tissue or that have been cut or torn.

Surgery to repair brachial plexus nerves should generally occur within six to seven months after the injury. If nerve surgery occurs more than six to seven months after the injury, the muscles may not recover their function.

Types of surgery

  • Nerve graft. In this procedure, the damaged part of the brachial plexus is removed and replaced with sections of nerves harvested from other parts of your body. This helps restore your arm’s function.
  • Nerve transfer. When the nerve root has been torn from the spinal cord, surgeons often take a less important nerve that’s still attached to the spinal cord and connect it to the nerve that’s no longer attached to the spinal cord.

In some cases, surgeons may perform this technique at a level close to the targeted muscle in an effort to speed up recovery rather than doing a repair (nerve graft) farther from the muscle. Sometimes doctors may perform a combination of nerve graft and nerve transfer.

Nerve tissue grows slowly, about an inch (2.5 centimeters) a month, so it can take several years to know the full benefit of surgery. During the recovery period, you must keep your joints flexible with a program of exercises. Splints may be used to keep your hand from curling inward.

  • Muscle transfer. Muscle transfer is a procedure in which your surgeon removes a less important muscle or tendon from another part of your body, typically the thigh, transfers it to your arm, and reconnects the nerves and blood vessels supplying the muscle.

Pain control

Pain from the most severe types of brachial plexus injuries has been described as a debilitating, severe crushing sensation or a constant burning. Narcotic medications are often used initially, but may be changed as your recovery progresses to optimize pain relief.

Lifestyle changes & home remedies

What are some lifestyle changes or home remedies that can help me manage brachial plexus injury?

The following lifestyles and home remedies might help you cope with brachial plexus injury:

  • For yourself. If you temporarily lose the use of your hand or arm, daily range-of-motion exercises and physical therapy can help prevent joint stiffness. Avoid burns or cuts, as you may not feel it if you’re experiencing numbness. If you’re an athlete who has experienced several injuries to the brachial plexus area, your doctor may suggest you wear specific padding to protect the area during sports.
  • For your child. If you’re the parent of a child with a brachial plexus palsy, it’s important that you exercise your child’s joints and functioning muscles every day, beginning when your baby is about 3 weeks old. This helps prevent the joints from becoming permanently stiff and keeps your child’s working muscles strong and healthy.

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Review Date: September 13, 2017 | Last Modified: September 13, 2017

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